Making Andrew Carnegie Proud
By Robert Leech
Many proprietary home health agencies are owned by amazing entrepreneurs. Those entrepreneurs who are willing to take risks and start new businesses are indispensable drivers in our economy. At one time or another, every great company was a start-up fueled by the dreams of a daring entrepreneur. Over the past few decades these innovators have created jobs and made vital contributions to our health care delivery system.
One entrepreneur who could really deliver results was the great Andrew Carnegie. He had a fascinating life and offered many bits of advice, including this one: “Concentrate your energies, your thoughts, and your capital. The wise man puts all his eggs in one basket and watches that basket.” Sounds odd because we have all heard it said a thousand times that we should not put all of our eggs in one basket.
But perhaps the standard advice doesn’t apply to highly skilled entrepreneurs who are passionate about watching their baskets. In the years I have worked in home health I have been fortunate to know many entrepreneurs like this. I consider them great friends and great business partners in facing the challenges ahead.
Today’s home health environment is tough. Competition is as rugged as it has ever been. Medicare requirements are more stringent than ever. Margins are rapidly thinning. Recruitment is difficult, and no agency or owner can do it all. While there is a pressing need to be proficient and vigilant on every front, the one aspect of the business that should top the priority list is patient satisfaction. Great companies know that customer service and product quality can never be compromised. Great service builds loyalty. Great service builds great companies. If you need to put all of your eggs in one basket, make it the customer service basket.
One of the best concepts that CMS has created for the home health industry is the Home Health Care Consumer Assessment of Healthcare Providers and Systems Survey (HH-CAHPS) requirement. HH-CAHPS has provided home health agencies with an opportunity to take a fresh approach to customer service and patient satisfaction. Smart agencies realize that patient satisfaction is about more than just a number. It is about a satisfied patient who received a valued service from the employees of a home health organization and was pleased with the results. HH-CAHPS offers home health entrepreneurs the opportunity to excel in an area that counts. If the owner of a local agency provided the very best home health service in the community and could unquestionably prove that with comparative scores, that owner could corner the market.
In spite of all the challenges we have as home health providers, leading the market in patient satisfaction would be a story that could be told over and over to case managers, physicians, families, insurance companies and ACOs. It is a compelling argument that truly one home health agency is better than the others. The agency that leads in that aspect of the business could easily prove they lead in other key areas as well.
Quality is sometimes an elusive factor to measure. However, there is nothing elusive about publicly reported patient satisfaction scores. They are the strongest and most objective measure of quality we have. They are also so fundamental that everyone can understand them without further explanation.
Again, it is important to remember that patient satisfaction is not just a matter of dry numbers. A satisfied patient is a happy customer and therefore a healthier patient.
One of the most powerful global domains in the HH-CAHPS structure is the patient’s recommendation of the agency’s services. Nothing is stronger than word-of-mouth advertising. It is one thing to have a great marketing rep, a great website, and a great strategy; but it is even more powerful to have happy patients who would “definitely recommend” your service to others. While we do not want to discount the other domains, they are largely a compilation of other questions and perceptions. A recommendation is more powerful. Many of us choose a physician, an automobile, or a school for our children based on the recommendations of others. In society we live by the recommendations of those we know and trust. It’s no different for home care.
Acute-care hospitals are covered by the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (H-CAHPS) program. One key domain area of H-CAHPS is “patients who reported that they were given information about what to do during their recovery at home.” Home health agencies that can prove they take good care of patients at home can show hospitals that they can improve a hospital’s scores in this key area and others. Patients’ responses regarding their discharge from the acute-care hospital to the home can be driven by the care they receive from their home health agency. A good agency will ensure a good handoff from hospital to home and that will partly determine the patient’s satisfaction with the hospital care they received. That shows an agency’s value, no matter their size.
One time, I was talking with a good friend who mentioned something about the “mom and pop” home health agency down the street and seemed dismissive of their ability to compete simply because they were a mom and pop agency. I reminded him that the mom and pop agency may be the agency that he could trust most with his own family member and we should never sell a locally owned and operated agency short in terms of its ability to compete on any level, especially service. Mom and pop agencies do a great job because their eggs are all in one basket and that basket is important to mom and pop.
In closing, another great quote from Carnegie: “The first man gets the oyster; the second man gets the shell.” Lead the way in patient satisfaction, and you will never get a shell. Build a home health company that Andrew Carnegie would be proud of.
Robert Leech is vice president for home health at HealthSouth Corporation in Birmingham, AL. He is a former president of the Tennessee Association for Home Care & presently serves as a member of NAHC’s Proprietary Home Care Association of America advisory board. He can be reached at Robert.Leech@healthsouth.com.